Ziquan Li
Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical
Title: Severe complications and successful management of a patient with myasthenia gravis undergoing cervical spinal surgery
Biography
Biography: Ziquan Li
Abstract
Introduction: Surgical management of patients with comorbid long-term myasthenia gravis is particularly challenging. We herein report a rare case of a patient with myasthenia gravis with cervical spondylosis and cervical spondylotic myelopathy who developed severe postoperative complications but ultimately underwent successful cervical spinal surgery.
Case presentation: A 62-year-old Chinese man with a 20-year history of myasthenia gravis was admitted to Peking Union Medical College Hospital with complaints of unstable gait, loss of manual dexterity, and numbness of both upper limbs. He safely underwent anterior cervical corpectomy of C4, discectomy of C5-6, and fusion of C3-6 under general anesthesia without muscle relaxants. The patient suffered from progressive dysphagia, bucking, hyperpyrexia, and transient loss of consciousness 10 days after the initial operation. Imaging revealed titanium cage subsidence and graft dislodgement. Secondary surgery was performed for posterior internal fixation from C2-7 and anterior revision from C3-6 after Halo-Vest traction, and antibiotic and immunoglobulin therapy. He underwent a series of postoperative treatments including cervicothoracolumbosacral orthosis, nebulization, vibration expectoration, anti-infective treatment, and nutritional support. His condition improved markedly and he had no recurrence of symptoms during the 6-month follow-up.
Conclusions: We present a rare case of cervical spinal surgery in a patient with myasthenia gravis and discuss the likely complications and preventive measures for patients with this condition. A posterior approach, intraoperative monitoring, osteoporosis, postoperative strong brace protection, and supportive management should be considered in patients with cervical spondylosis and comorbid myasthenia gravis.